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Inside Dentistry
February 2016
Volume 12, Issue 2

Because of the added complexity, Twersky and other authorities recommend outsourcing the billing for treating OSA patients. “A lot of companies will want to sell you a billing program, but because the documentation is so overwhelming, it’s just better to find a reputable billing agency. You have to actually fight the insurance company. It requires about six ‘no’s’ before you get a ‘yes.’”

Twersky also warns that dentists entering the field of dental sleep medicine should be aware of the need for interdisciplinary coordination. “It’s the first time in the dental industry that the dentist is not the quarterback. The dentist is part of the team, and the quarterback is the MD.” The need for a team approach may require an adjustment in thinking. Nonetheless, those who adjust can significantly expand their revenue, Twersky believes.

Future Considerations

If Jeffrey S. Rouse, DDS, an expert in “sleep prosthodontics” who practices in San Antonio, Texas, is correct, there’s also a lot more work to be done relating to airway disorders beyond those manifesting during sleep. “Sleep is just one part of it,” Rouse says. “Airway problems are progressive. It’s an airway system, and problems are magnified when the person is sleeping. But all day long you have to manage the airway.” Rouse argues that dentists can and should spot intraoral signs of airway issues at their inception, rather than when they have developed into disease states.

“We focus on apnea because it’s easy to measure,” he says, “but our scope is really too limited.” It’s not just middle-aged men who are affected; children are being damaged quite dramatically by airway problems,17 he contends. Young, fit females are vulnerable to Upper Airway Resistance Syndrome.18 “The true number of people who are impacted by airway and sleep issues is staggering.”

References

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2. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773-827.

3. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829-1836.

4. Beninati W, Harris CD, Herold DL, Shepard JW Jr. The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners. Mayo Clin Proc. 1999;74(10):955-958.

5. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862-865.

6. Giles TL, Lasserson TJ, Smith BJ, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006;(3):CD001106.

7. Somiah M, Taxin Z, Keating J, et al. Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med. 2012;8(5):489-500.

8. Tokunaga T, Nimomiya T, Kato Y, et al. Long-term compliance with nasal continuous positive airway pressure therapy for sleep apnea syndrome in an otorhinolaryngological office. Eur Arch Otorhinolaryngol.2013;270(8):2267-2273. doi: 10.1007/s00405-013-2483-3.

9. Demko BG. Incorporating dental sleep medicine into a practice: avoiding the “7 deadly sins.” Compend Contin Educ Dent. 2014;35(9):640,642.

10. Itzhaki S, Dorchin H, Clark G, et al. The effects of 1-year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest. 2007; 131(3):740-749.

11. Scherr SC, Dort LC, Almeida FR, et al. Definition of an effective oral appliance for the treatment of obstructive sleep apnea and snoring. Journal of Dental Sleep Medicine. 2014;1(1):51.

12. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. Journal of Dental Sleep Medicine. 2015;2(3):71-125. Available from: Clinical Practice Guideline for Oral Appliance Therapy. American Academy of Dental Sleep Medicine website. www.aadsm.org/oatguideline.aspx. Accessed December 22, 2015.

13. Scherr, SC. Oral Appliance Therapy for the Future. Sleep Review. 2014;15(1):12-16.

14. Fenton ME, Stewart SA, Skomro R, et al. Utility of STOP-Bang in the prediction of obstructive sleep apnea in primary care. Chest. 2015;148(4_Meeting Abstracts):1033A. doi:10.1378/chest.2278516. 15. About Accreditation. American Academy of Dental Sleep Medicine website. www.aadsm.org/Accreditation.aspx. Accessed December 22, 2015.

16. Miller JN, Berger AM. Screening and assessment for obstructive sleep apnea in primary care. Sleep Med Rev. 2015;29:41-51. doi: 10.1016/j.smrv.2015.09.005. [Epub ahead of print].

17. Rouse JS. Sleep prosthodontics: a new vision for dentistry. Inside Dentistry. 2013:9(7):60-76.

18. Gold AR, Dipalo F, Gold MS, O'Hearn D. The symptoms and signs of upper airway resistance syndrome. Chest. 2003;123;87-95.

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